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[Pylephlebitis: a rare but possible complication of intra-abdominal infections]
Susana Pérez-Bru1, Carmen Nofuentes-Riera1, Andrés García-Marín1
1Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario San Juan de Alicante, Alicante, España.
Background:
Pylephlebitis or septic thrombophlebitis of the portal venous system is a rare but serious complication of intra-abdominal infections which drain into the portal venous system. Its diagnosis is based on clinical suspicion and imaging tests, mainly a computed tomography scan, given the lack of specificity of the signs and symptoms. Spread of septic emboli is the major cause of morbidity and mortality. The aim of the study was to analyse patients diagnosed in our hospital.
Material And Methods:
Retrospective descriptive study of patients diagnosed with pylephlebitis in our hospital.
Clinical Cases:
Four patients were included, 3 men and one woman. In 3 cases it was acute cholecystitis that led to the diagnosis of pylephlebitis at the same time as the intra-abdominal infection. Emergency surgery was performed in one case, whilst the other 2 were treated conservatively. Blood cultures were performed in all cases, and empirical antibiotic treatment was used. In the only case of acute appendicitis, diagnosis of pylephlebitis was achieved during the study of postoperative fever, with empirical antibiotic treatment also being started. The haematologist was requested to start the required anticoagulation therapy in all cases.
Conclusions:
Pylephlebitis is a rare complication of intra-abdominal infections that may make lead to a worse outcome. A high level of suspicion is required as well as imaging tests to make an early diagnosis and appropriate treatment.
Insights
Pylephlebitis, a rare septic thrombophlebitis of the portal venous system, requires high suspicion and imaging for early diagnosis. Prompt treatment is crucial for better outcomes in patients with intra-abdominal infections.
Area of Science:
- Internal Medicine
- Gastroenterology
- Infectious Diseases
Background:
- Pylephlebitis, or septic thrombophlebitis of the portal venous system, is a rare but severe complication of intra-abdominal infections.
- Diagnosis relies on clinical suspicion and advanced imaging like CT scans due to non-specific symptoms.
- Septic emboli spread poses a significant risk for morbidity and mortality.
Observation:
- A retrospective study analyzed patients diagnosed with pylephlebitis.
- Four cases were identified: three linked to acute cholecystitis and one to acute appendicitis.
- Treatment involved conservative management, emergency surgery in one case, empirical antibiotics, and anticoagulation therapy.
Findings:
- Pylephlebitis can arise from common intra-abdominal infections such as appendicitis and cholecystitis.
- Early diagnosis through high clinical suspicion and imaging is critical.
- Multifaceted treatment including antibiotics and anticoagulation is essential.
Implications:
- Highlights the importance of considering pylephlebitis in patients with intra-abdominal infections and concerning symptoms.
- Emphasizes the need for prompt diagnostic workup, including imaging, to facilitate timely intervention.
- Suggests that early and appropriate management can improve patient outcomes and reduce mortality associated with this rare condition.
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